Postoperative Transthoracic Echocardiography Following Penetrating Cardiac Injury: Moving From Routine Use to a Risk-Stratified Approach.

Abstract

BackgroundPatients undergoing surgical repair of penetrating cardiac injury are routinely evaluated postoperatively with a transthoracic echocardiogram (TTE). We hypothesized that patients undergoing a single operation for penetrating cardiac injuries without the need for cardiopulmonary bypass (CPB), coronary artery bypass grafting (CABG), or additional staged procedures do not benefit from routine postoperative TTEs.MethodsA retrospective chart review of patients presenting with cardiac injuries to a level I trauma center from January 2018 to March 2025 was performed. Patients with a blunt mechanism, age <18 years, or no identifiable penetrating cardiac injury were excluded. Demographic data, injury characteristics, postoperative care and complications, and TTE findings were analyzed.ResultsThirty-eight patients with penetrating cardiac injuries were identified. Twenty-one patients died within 4 hours of arrival, and 2 patients underwent advanced procedures (ie, CPB and CABG), leaving 15 patients for analysis. Thirteen (87%) were male with an average age of 36. The Median Injury Severity Score (ISS) was 26, with a median American Association for the Surgery of Trauma (AAST) heart injury grade of 3. Fourteen (93%) patients survived to discharge. Eight (53%) of the fifteen patients underwent postoperative TTEs, none of which revealed clinically significant findings relative to their procedure.DiscussionRoutine postoperative TTE demonstrated low clinical utility in this cohort. These findings support a selective approach to TTE based on injury complexity and clinical indicators. Postoperative TTE may be deferred in asymptomatic patients following uncomplicated repair but remains indicated in patients with new cardiac symptoms, higher-risk injury patterns, or complex operative repair.